External apparatus for motor handicaps of at least one upper limb

ABSTRACT

An external orthesis for motor handicaps of the upper limb, comprising a thoraco-scapular structure formed of a shoulder brace and a belt assembly, with a para-skeleton for the upper limb and hand. The construction of the orthesis is such that all of the physiological joints are held under compression and the weight of the handicapped limbs is dynamically neutralized. Operation of the scapular motor results in manipulation of the various physiological joints and use of the orthesis speeds recovery of sensitivity and mobility.

FIELD OF THE INVENTION

The present invention relates to an external apparatus for motorhandicaps of at least one upper limb. This apparatus allows the subjectto use his handicapped limb by using exclusively the energy coming fromthe scapular motor.

BACKGROUND OF THE INVENTION

Until now, in the state of the art, three types of ortheses have beenproposed for the upper limb: in the first type, the various parts of thelimb are tightly held in shells which are actuated with respect to eachother by means of motor devices controlled by the subject, such as, forinstance, an electric motor or an artificial inflatable muscle; in thesecond type, the limb is supported in a given position by means of arigid frame; in the third type, the limb is supported by an externalrigid structure articulated at several points by pins so as to allow agiven mobility of the various parts of the limb with respect to eachother, but the subject can only control the movements of his limb by anexternal action, either with an external motor or by an action of hisother limb. In all these cases, the limb is entirely supported and themovement of the joints when it does exist, is far more limited than thephysiological movement of the joints.

On the contrary, according to the invention, the limb may have all thenormal physiological movements, the joints being capable of operating inall the admissible physiological directions and the control of the limbis effected by the subject himself, without the help of an externalmotor, by operating the scapular motor constituted by the structure ofthe shoulder. Depending on whether, by the movements of his shoulder,the subject opens or closes the scapular cone constituted at the levelof the connection of the shoulderblade and the clavicle, he produces anaction on the humerus which, by means of the apparatus according to theinvention, results in a set of actions on all the parts of the limbwhich cause the joints to operate within the constraints of the normalphysiological movement.

OBJECTS OF THE INVENTION

The object of the present invention is to provide an autonomous orthesiswhich ensures that the limb joints are placed in compression by meansneutralising the weight of the limb in a dynamic manner. One thus allowsthe motor units to be informed and reactivated by a modulation of thefalling of the handicapped limb with respect to time and space; one thusimproves and accelerates the overall recovery of the voluntary grippingmovement.

BRIEF DESCRIPTION OF THE INVENTION

The invention therefore provides an external apparatus for motorhandicap of at least one upper limb, the said apparatus allowing thesubject to move his handicapped limb, characterised in that itcomprises, for each handicapped limb,

(a) on the one hand, a thoraco-scapular structure constituted by twosub-assemblies:

firstly, a shoulder brace formed by at least three semi-rigid shellswhich are interconnected in a flexible manner, the first being disposedover the upper angle of the pectoral muscle and passing over the upperedge of the trapezius, the second being disposed over theclavico-trapezoidal zone at the top of the shoulder, the third beingdisposed opposite the scapula, there being at least one elastictensioner between the second shell and each one of the two others;

secondly, an attachment sub-assembly disposed around the torso andconnected to the above mentioned shoulder brace at at least threefastening points distributed over either side of the shoulder;

(b) on the other hand, a para-skeleton for the upper limb and the handcomprising;

firstly, five elements to connect with the limb and disposedrespectively at the level of the upper and lower humeral parts, of theupper and lower cubito-radial parts and of the hand, the upper humeralconnection element comprising the second shell of the shoulder brace anda peripheral strap surrounding the limb, each one of the other fourconnector elements comprising a semi-rigid shell made in one, or severalpieces and at least one peripheral strap surrounding the limb;

secondly elastic means disposed between the two above mentionedconnection elements comprising:

a first spring lever operating in flexion and torsion, fixed between thesecond shell of the shoulder brace and the shell of the lower humeralconnection element, substantially parallel to the humerus along theexternal edge of the limb,

a second spring lever analogous to the first, fixed between the shell ofthe upper cubito-radial connection element and the shell for the hand,substantially parallel to the cubitus along the internal edge of thelimb,

two elastic tensioners disposed on the external and internal edges ofthe arm, between the lower humeral and upper cubito-radial connectionelements, and

two elastic tensioners disposed between the lower cubito-radialconnection element and the connection element for the hand.

In a preferred mode of embodiment, the attachment sub-assembly isconnected to the shoulder brace at three attachment points, the firstsituated in the anterior zone of the first shell of the shoulder brace,the second situated in the lower zone of the third shell, and the thirdsituated in the upper internal zone of the third shell; advantageously,the attachment subassembly is constituted by:

a belt passing around the subject at waist level, the said belt mayassume larger or narrower widths and may constitute a corset, the saidbelt being single if the subject is handicapped in both upper limbs andcarries an apparatus for each one of the two limbs;

an anterior linkage constituted by a thoracic transmission element andan elastic connector, the said transmission element having an end fixedon the belt at the level of the iliac spine on the side opposite theequipped limb and having its other end connected by the above mentionedelastic connector to the first shell of the shoulder brace;

a first lateral elastic linkage held between the belt at the level ofthe iliac spine on the side of the equipped limb and the third shell ofthe shoulder brace;

a second lateral elastic linkage held on the side opposite the equippedlimb, between the third shell of the shoulder brace and the abovementioned anterior linkage.

According to a preferred embodiment, the thoracic transmission elementis a spring lever which forms an angle of approximately 30° with theaxis of the subject's body; the first lateral elastic linkage isconnected to the third shell of the shoulder brace opposite the base ofthe shoulder blade and the second elastic lateral linkage is connectedto the third shell of the shoulder brace, near the inner part of theshoulder blade spine.

Provision may advantageously be made for the second shell of theshoulder brace to be connected to the third shell of the said shoulderbrace by a tensioner fixed between the upper posterior zone of thesecond shell and the central zone of the third shell, a deflector guideconstraining the tensioner to pass opposite the extenal part of theshoulder blade spine; similarly, provision may be made for the secondshell of the shoulder brace to be connected to the first shell by atensioner fixed between the upper anterior zone of the second shell andthe internal posterior zone of the first shell, a deflector guideconstraining the tensioner to remain opposite the clavicular zone overapproximately half of its length. These deflector guides for thetensioners may be constituted by pulleys.

The spring levers of the apparatus according to the invention generallywork in flexion and in torsion. They are advantageously constituted byflexible metal blades made, in particular, of steel with pronouncedelastic characteristics.

In a preferred mode of embodiment, the element for the lower humeralconnection and the element of the upper cubito-radial connection eachcomprise a single shell, the two shells having their adjacent edgesseparated by an articular gap having a substantially constant widthcomprised between approximately 5 and 15 mm and being connected oppositethis gap by elastic means disposed on either side of the olecranon, theedge of the lower humeral shell along the said gap having a convex shapeopposite the epicondyle and the epitrochlearis and a concave shapeopposite the olecranon, the edge of the upper cubito-radial shell havinga complementary shape; the lower or upper humeral connection elementcovers, advantageously, approximately the lower third of the upper arm;the shell of the lower cubito-radial connection element is constitutedby two half shells covering respectively the radial and cubital parts ofthe limb, these two half shells being separated by a groove opposite thecubitus, the limb being introduced into the shell on the side oppositethe groove, the two half shells being tightened around the limb by twoperipheral straps disposed at the upper and lower ends of the saidshell; the element of the lower or upper radial connection coversapproximately one third of the fore-arm.

In a preferred embodiment, the connection element for the handcomprises:firstly, a shell constituted by three segments, the firstsegment covering the thenar eminence, the second segment covering thesecond, third and fourth carpal and metacarpal bones as far as the baseof the fingers, the third segment covering the hypothenar eminence; andsecondly, (a) a first peripheral strap disposed over the above mentionedfirst and second segments and surrounding the hand, with the exceptionof the thumb at the level of the lower part of the metacarpal bones, and(b) a second peripheral strap surrounding the carpus and passing overthe three segments near the wrist, the said second peripheral strapbeing connectd to the lower cubito-radial connection element by a rubberstrap; the connection element for the hand is connected to the lowercubito-radial connection element by two tensioners, the one between thebase of the thumb and the lower radial zone and the other between thelower cubital zone and the central palmar zone of the metacarpus passingdiagonally above the hand; the second spring lever of the apparatus isdisposed opposite the gap between the cubitus and the inner edge of theforearm and it has its lower end fixed on the third segment of the shellof the connection element for the hand, somewhat ahead of the pisiformbone.

In a first variant of the embodiment of the connection element for thehand, a strap carried by the first segment of the shell of the handsurrounds the base of the thumb, the other fingers of the hand not beingfitted with the apparatus. In a second variant, each finger of the handis fitted with an elastic crossed tensioner disposed between asupporting end fitting placed above the metacarpus and a supporting endfitting placed above the second phalanx; the supporting end fittingplaced at the level of the metacarpus is carried by the segment of theshell of the hand which corresponds to it and the supporting end fittingplaced at the level of the second phalanx is carried by a finger stallwhich surrounds the end of the finger, each supporting end fittingcomprises preferably an adjustable angular orientation element capableof turning around an axis substantially perpendicular to the bone whichit surmounts.

DESCRIPTION OF THE DRAWINGS

To render the object of the invention more readily understood, therewill now be described, by way of a purely illustrative andnon-restrictive example, a mode of embodiment represented in theattached drawings.

In these drawings:

FIG. 1 shows a schematic front view of an apparatus according to theinvention carried by a subject with a motor handicap of the left arm;

FIG. 2 shows a schematic posterior view of the apparatus of FIG. 1;

FIG. 3 shows an external side view of the apparatus of FIGS. 1 and 2.

FIG. 4 shows, in perspective, a first variant of the shell of the handwherein the first segment is fitted with a strap to support the thumb;

FIG. 5 shows, in plan, a second variant of the embodiment of the linkageelement for the hand wherein each finger is fitted with a crossedtensioner;

FIG. 6 shows schematically in an exploded perspective, the embodiment ofa supporting end fitting for the crossed tensioners of FIG. 5.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring to the drawings , it will be seen that the apparatus showncomprises a thoraco-scapular structure constituted by a shoulder braceand a fastening sub-assembly.

The shoulder brace is formed by two semi-rigid shells made of a mouldedplastic material. The first shell 1 is disposed over the upper angle ofthe pectoral muscle and passes over the upper edge of the trapezius. Thesecond shell 2 is disposed over the claviculo-trapezoidal zone at thetip of the shoulder. The third shell 3 is disposed opposite the scapula,that is to say, on the shoulder blade (FIG. 2). These three shells,1,2,3 are interconnected by rubber bands, but they are separated fromeach other by sufficient space to allow relative motion between them.The shape of these shells is anatomically adapted to the particularsubject who is to wear them.

Shell 2 of the shoulder brace is joined to a peripheral strap 4 which isintended to surround elastically the upper part of the arm, the gripbeing ensured by a releasable fastening known under the commercialdesignation of "VELCRO" for instance. Shell 2, is moreover, connected toshell 3 by a tensioner 5 attached to shell 2 at a point of thepostero-upper zone of this shell and to shell 3 opposite the subspinalpart of the shoulder blade, substantially in the central zone of theshoulder blade. Tensioner 5 passes over a pulley 6 carried by shell 3 ata point situated at the level of the spine of the shoulder blade,substantially at a distance of one third, starting from the outside.

Shell 2 is also connected to shell 1 by a tensioner 7 attached to shell2 at a point of the upper part of this shell which is at the level ofthe cradle of the biceps. Tensioner 7 is attached to shell 1 at a pointsituated opposite the inner sub-spinal portion of the shoulder blade inthe zone of the insertion of the trapzius. Tensioner 7 passes over apulley 8 carried by shell 1 and disposed opposite the coracoid.

The rubber band connecting shells 1 and 2 is disposed towards the frontof the central deltoid muscle towards the clavicle. The rubber bandensuring the linkage between shell 2 and shell 3 is disposed towards theback of the central deltoid muscle towards the spine of the shoulderblade. The shapes of shells 1, 2, 3 and the linkages fitted provide adisplacement angle for the arm in relation to the shoulder ofapproximately 45° towards the front or towards the back. The rubber bandensuring the linkage between shells 1 and 3 is disposed substantiallyabove the spine of the shoulder blade.

The second sub-assembly of the thoraco-scapular structure is theattachment sub-assembly. This sub-assembly comprises a belt 9 passinground the subject at waist level. To this belt, there is joined ananterior linkage constituted by a thoracic spring lever 10 and anelastic connector 11. The thoracic spring lever 10 is attached to belt 9at the level of the iliac spine at the opposite side from the limbfitted with the apparatus; it is connected to the elastic connector 11at the level of the xiphoid process, that is to say, at the tip of thesternum. The elastic connector 11 is attached to shell 1 of the shoulderbrace at a point situated on the lower anterior part of shell 1 belowthe clavicle. The elasic connector 11 is constituted by an elastic band;the thoracic spring lever 10 is constituted by a metal steel blade ofthe type "XC75", the blade having a thickness of 0.5 mm and a width of25 mm; the length of the blade depends on the subject's anatomy. Itwould be possible to consider replacing this spring lever 10 by athoracic transmission element which would be solely constituted by astrap, but the result seems less satisfactory in this case as regardsthe transmission of the energy from the scapular motor to thehandicapped limb.

Belt 9 is connected by a first lateral elastic linkage 12 with shell 3of the shoulder brace. The lateral elastic linkage is constituted by anelastic strap; it is attached to belt 9 at the level of the iliac spineon the side of the equipped limb; it is attached to shell 3 at the levelof the tip of the shoulder blade.

Between the junction zone of spring lever 10 with the elastic connector11 on the one hand, and shell 3 on the other, there is a second laterallinkage 13 constituted by an elastic band. The point of attachment ofband 13 on shell 3 is disposed in the upper internal zone of shell 3slightly below the inner end of the shoulder blade spine. Thepositioning of band 13 is such that the mamilla of the side opposite tothe equipped limb remains free.

The apparatus according to the invention associates the thoraco-scapularstructure described above with a para-skeleton for the upper limb andthe hand. This para-skeleton comprises five linkage elements with thehandicapped limb. The upper humeral linkage element is constituted byshell 2 and the peripheral strap 4; it extends substantially over onethird of the length of the upper arm. The lower humeral linkage elementis constituted by a shell 14 which has, on the inner side of the arm, anopening allowing this limb to be introduced. Shell 14 is kept inposition on the limb by means of a peripheral strap 15 and thecombination 14, 15 covers the lower humeral part of the upper arm overapproximately one third of the length of the upper arm. The peripheralstrap 15 is constituted by two bands, each analogous to band 4, disposedat the upper and lower ends of shell 14.

The linkage element for the upper cubito-radial parts also comprises ashell 16 analogous to shell 14. Shell 16 is also open on the side of theinner part of the forearm; it is fixed on the forearm by a peripheralstrap 17, constituted by two elastic bands each analogous to band 4, thetwo bands being placed at the upper and lower ends of shell 16. Shells14 and 16 are separated at the level of the elbow by a gap 18 which hasa substantially constant width and equal to 8 mm. To permit thearticulation of the forearm in relation to the upper arm, the lower edgeof shell 14 has two rounded convex shapes 14a opposite the epicondyleand the epitrochlearis, these two convex shapes being separated by arounded concavity 14b opposite the olecranon. The upper edge of shell 16has a complementary shape so that the articular gap 18 remains at asubstantially constant width. This cut out allows a relative movement ofshell 16 in relation to shell 14 which corresponds to the elbow joint.Shells 14 and 16 are linked by two tensioners 19 and 20 disposed oneither side of the olecranon above the articular gap 18. Moreover,shells 14 and 16 are interconnected by two elastic tensioners 21 and 22,disposed respectively in the hollow of the elbow on the inner and outeredges of the limb.

The lower cubito-radial linkage element comprises a shell constituted bytwo half shells 23, 24 covering respectively the radial part and thecubital part of the forearm. These two half shells are separated by agroove 25 and they are held tight around the limb by two peripheralstraps 26 disposed at two upper and lower ends of the said shell 23, 24.The lower cubito-radial linkage element extends over substantially thelower third of the forearm. The limb is introduced between the two halfshells 23, 24 on the opposite side to groove 25.

The linkage element for the hand comprises a shell constituted by threesegments 27, 28, 29. Segment 27 covers the thenar eminence. Segment 28covers the second, third and fourth carpal and metacarpal bones as faras the base of the fingers. The third segment 29 covers the hypothenareminence. These three segments are kept in position on the calix of thehand by means of two peripheral straps. A first peripheral strap 30 isdisposed over the segments 28 and 29 at the level of the metacarpalbones and it surrounds the hand with the exception of the thumb. Asecond peripheral strap 31 surrounds the carpus and passes over thethree segments 27, 28, 29 near the wrist. The peripheral straps 30 and31 have a width of approximately 2 cm. The first peripheral strap 30 isconnected elastically to the lower cubital zone of half shell 24 by anelastic tensioner which passes diagonally over the carpus and metacarpusand is fixed in the palmar portion of strap 30 substantially oppositethe base of the second finger. An elastic tensioner is disposed betweenthe lower radial zone of half shell 23 and segment 27 at the level ofthe base of the thumb. The linkage element for the hand is connected tothe lower cubito-radial linkage element by a rubber band disposed overthe wrist.

All the shells 14, 16, 23, 24, 27, 28, 29 of the para-skeleton are madeof a moulded plastic material conforming to the anatomy of the subject.All the peripheral straps 15, 17, 26, 30, 31 are analogous to strap 4.

In the first variant represented in FIG. 4, segment 27 is fitted with astrap 27a forming a loop and surrounding the base of the column of thethumb. This strap 27a may be constituted by an elastic band inserted atthe lower end of segment 27. The other fingers are not equipped.

In a second variant represented in FIGS. 5 and 6, each one of thefingers of the hand is equipped. In this case, each one of segments 27,28, 29 carries, opposite each one of the metacarpal bones, a supportingend fitting designated by 40 as a whole. Segment 27 thus carries one endfitting 40; segment 28 carries three end fittings 40; and segment 29carries one end fitting 40. All the end fittings 40 are identical. Eachend fitting 40 is constituted by a base 40a of triangular shapesupporting a cylindrical pin 40b substantially perpendicular to the bonewhich it surmounts. On base 40a, there rests a triangular guide plate40c which is fitted on pin 40b and which is kept in position againstbase 40a by a triangular cover 40d of the same shape and same dimensionsas base 40a, cover 40d also being fixed on pin 40b. The stack 40a, 40c,40d, is kept together tightly for example, by catch engagement of lid40d on the tip of pin 40b. The position of guide plate 40c between base40a and cover 40d is adjustable by rotation around pin 40b but becauseof the tight grip of the stack, this position is maintained afteradjustment by the friction of guide plate 40c between base 40a and cover40d. The facing surfaces may be granulated or striated to ensuresatisfactory friction.

Each one of the fingers of the hand is fitted at the level of the secondphalanx with a finger stall 41 having a slightly frustoconical shape.Each finger stall comprises an end fitting 40 identical with the onewhich has been previously described. All the end fittings 40 aredisposed on the back of the hand. For each of the fingers of the hand,an elastic tensioner 42 is placed in position between the supporting endfitting 40 situated at the level of the second plalanx and the endfitting 40 situated at the level of the metacarpus. Tensioner 42 iscrossed X wise and passes around guide plate 40c of each of end fittings40 associated therewith. In this way, by suitably orientating the guideplate 40c of each one of the two supporting end fittings, one mayregulate the direction of the compressive stress applied to the fingerjoints. Tensioners 42 constitute elastic brakes for the closing of thehand.

The para-skeleton described above comprises, moreover, in a way that isessential for the functioning of the apparatus according to theinvention, two spring levers constituted by metal blades analogous tothe spring levers 10. The first spring lever 34 is fixed between a pointof the central zone of shell 2 of the shoulder blade and shell 14; it issubstantially parallel to the humerus along the outer edge of the arm.The second spring lever 35 is fixed between shell 16 and segment 29; itis substantially parallel to the cubitus opposite the space comprisedbetween the cubitus and the inner edge of the forearm. Its fastening onsegment 29 is effected somewhat ahead of the pisiform.

It will be seen that the apparatus described above allows a person witha motor handicap of the upper limbs to recover a certain mobility of hishandicapped limb.

In effect, the tensions of the various tensioners of the spring leversof the apparatus are adjusted so that in a rest position, the forearmshould form an angle of approximately 30° with the upper arm and thatthe wrist should be in slight dorsal flexion (approximately 10° in anupward direction); moreover, the fingers are in slight palmar flexion,(approximately 15° downward) and the thumb is in an abducted position soas to open the prehensile grip.

When the subject moves his shoulder backwards he opens the scapular coneconstituted by the shoulder blade and the clavicle which produces therising of the humerus. In this movement, the lever arm of the action ofthe weight of the forearm in relation to the elbow joint increases andthere results therefrom a slight extension by the opening of the elbowangle, the tensioners 21, 22 restraining this opening. Under the effectof the weight, the hand has a tendency to move downwards which ischecked by tensioners 32, 33. The hand has a tendency towards closingwhich is checked by tensioners 42.

If the subject raises his shoulder upwards and towards the front, areturn movement is effected with respect to the previous movement. Thehumerous is drawn back; the lever arm of the weight of the forearm inrelation to the elbow decreases and under the action of tensioners 21,22 the forearm rises again which slightly closes the elbow angle. Thehand turns slightly, tending to have the palm upwards and the fingersopen.

It will be seen, therefore, that the scapular motor allows, by combiningall the possible movements of the shoulder, the control of the apparatusaccording to the invention. The movements of the humerus, when thesubject displaces his shoulder, are not only controlled by thephysiological joints but also by the spring lever 34 which, being fixedto shell 2 of the shoulder brace, sustains tensile stresses applied tothe shoulder brace by the attachment means 9, 10, 11 12, 13. Themovement is transmitted from the arm to the hand by spring lever 35,thus the weight of the handicapped limb is neutralised dynamically.

It has been found that the working of the limb equipped in this wayallows the motor unit to be reactivated which accelerates the recoveryof the gripping movement. Moreover, the subject who uses such anapparatus and makes use of his handicapped limb recovers a large part ofthe sensitivity of the limb in a spectacular way.

It shall be duly understood that the mode of embodiment described aboveis in no way restricted and may give rise to any desirable modificationswithout thereby departing from the scope of the invention.

I claim:
 1. An external apparatus for overcoming motor handicaps of atleast one upper limb of a human subject, to allow the said subject tomove his handicapped limb, such apparatus comprising, for eachhandicapped limb:(a) a thoraco-scapular structure constituted by firstand second thoraco-scapular sub-assemblies; (b) said firstthoraco-scapular sub-assembly being in the form of shoulder brace meanscomprising (b1) at least three semi-rigid shells, (b2) meansinterconnecting said semi-rigid shells in a flexible manner, with saidfirst semi-rigid shell disposed over the upper angle of the pectoralmuscle and passing over the upper edge of the trapezius of the subject,said second semi-rigid shell disposed over the claviculo-trapezoidalzone at the top of the shoulder of the subject, and said thirdsemi-rigid shell disposed opposite the scapula of the subject; and (b3)elastic tensioner means between said second semi-rigid shell and each ofsaid first and third semi-rigid shells; (c) said second thoraco-scapularsub-assembly being in the form of an attachment sub-assembly to bedisposed around the torso of the subject and connected to the shoulderbrace at at least two attachment points distributed on either side ofthe shoulder of the subject; (d) said apparatus comprising, in additionto said first and second thoraco-scapular sub-assemblies, apara-skeleton for the upper limb and for the hand of the subject, saidpara-skeleton comprising: (d1) first connection means to connect to thesaid limb of the subject and at the upper humeral part thereof, (d2)second connection means to connect to the limb of the subject at thelower humeral part thereof, (d3) third connection means to connect tothe limb of the subject at the upper cubito-radial part thereof, (d4)fourth connection means to connect to said limb of the subject at thelower cubito-radial part thereof, and (d5) fifth connection means toconnect to the hand of the subject; wherein said first connection meanscomprises said second shell of the shoulder brace means and a peripheralstrap which surrounds the said limb of the subject, and wherein each ofthe said first, second, third and fourth connection means comprises asemi-rigid shell each made of at least one piece, and at least oneperipheral strap which surrounds the said limb; and (d6) elastic meansdisposed between two of said first, second, third, fourth and fifthconnection means; (e) wherein said elastic means comprises: (e1) a firstspring lever operating in the flexural and torsional modes, (e2) meansfixing said first spring lever between the second shell of the shoulderbrace means and the said semi-rigid shell of the second connection meanswith said first spring lever substantially parallel to the humerus alongthe outer edge of the limb of the subject; (e3) a second spring leveranalogous to said first spring lever, (e4) means fixing said secondspring lever between said shell of the third connection means and theshell of the fifth connection means with said second spring leversubstantially parallel to the cubitus along the inner edge of the limbof the subject; (e5) two elastic tensioners disposed over the outer andinner edges of the arm of the subject, between said second and thirdconnection means; and (e6) two elastic tensioners disposed between saidfourth and fifth connection means.
 2. Apparatus according to claim 1,comprising means connecting the attachment sub-assembly constituting thesecond thoraco-scapular sub-assembly to said shoulder brace meansconstituting the first thoraco-scapular sub-assembly at three attachmentpoints, wherein said first attachment point is situated in the anteriorzone of said first semi-rigid shell of the shoulder brace means, saidsecond attachment point is situated in the lower zone of said thirdshell of the shoulder brace means, and said third attachment point issituated in the upper inner zone of said third shell of the shoulderbrace means.
 3. Apparatus according to claim 2, wherein said attachmentsub-assembly constituting the second thoraco-scapular sub-assemblycomprises:(g) a belt passing round the subject at wait level; (h) ananterior linkage, said anterior linkage being constituted by a thoracictransmission element having first and second ends, an elastic connector,and means fixing said first end of the transmission element on said beltat the level of the iliac spine of the subject on the side opposite thesaid handicapped limb, said second end of said transmission elementbeing connected to said first shell of the shoulder brace means by saidelastic connector, (i) a first lateral elastic linkage between the beltat the level of the iliac spine of the subject on the side of thehandicapped limb, and said third shell of the shoulder brace means; and(j) a second lateral elastic linkage on the opposite side to thehandicapped limb of the subject between said third shell of the shoulderbrace means and said anterior linkage.
 4. Apparatus according to claim3, wherein said thoracic transmission element is a spring lever whichforms an angle of approximately 30° with the axis of the body of thesubject; wherein the first lateral elastic linkage is connected to thethird shell of the shoulder brace means opposite the base of theshoulder blade of the subject; and wherein the second lateral elasticlinkage is connected both to said third shell of the shoulder bracemeans near the inner part of the shoulder blade spine of the subject,and to the anterior linkage near the xiphoid appendage of the subject.5. Apparatus according to claim 1, including a tensioner connecting saidsecond shell of the shoulder brace means to said third shell thereof,said tensioner being fixed between the upper posterior zone of thesecond shell of the shoulder brace means and the central zone of thethird shell thereof; and further including a deflector guideconstraining said tensioner to pass opposite the outer part of theshoulder blade spine of the subject.
 6. Apparatus according to claim 1,including a tensioner connecting said second shell of the shoulder bracemeans to said first shell thereof, said tensioner being fixed betweenthe upper anterior zone of the second shell of the shoulder brace meansand the inner posterior zone of the first shell thereof; and furtherincluding a deflector guide constraining said tensioner to remainopposite the clavicular zone of the subject over approximately half ofits length.
 7. Apparatus according to claim 5, wherein said deflectorguides for the tensioners are constituted by pulleys.
 8. Apparatusaccording to claim 6, wherein said deflector guides for the tensionersare constituted by pulleys.
 9. Apparatus according to claim 1, whereinsaid first and second spring levers are constituted by flexible metalblades.
 10. Apparatus according to claim 1, wherein said second andthird connection means each comprise a single shell, said single shellshave their adjacent edges separated to define articular gap means of asubstantially constant width, and including elastic means disposed oneither side of the olecranon of the subject and connecting said singleshells opposite said articular gap means; wherein said shell of thesecond connection means have an edge along said articular gap meanswhich edge has a convex shape opposite the epicondyle and theepitrochlearis of the subject and a concave shape opposite the olecranonof the subject; and wherein said shell of the third connection means hasan edge of complementary shape.
 11. Apparatus according to claim 1,wherein said fourth connection means comprise a shell assembly of firstand second half shells covering respectively the radial part and thecubital part of the limb of the subject, and groove means separatingsaid first and second half shells opposite the cubitus of the subject,wherein the limb of the subject can be introduced into said shellassembly through the side opposite said groove means, and includingperipheral strap means fastened around the limb of the subject and saidfirst and second half shells.
 12. Apparatus according to claim 1,wherein said fourth connection means comprises a shell having upper andlower ends, and two peripheral straps disposed at said upper and lowerends of the said shell for fastening around the limb of the subject. 13.Apparatus according to claim 1, wherein said first and second connectionmeans are dimensioned to cover approximately one third of the upper armof the subject and said third and fourth connection means aredimensioned to cover approximately one third of the forearm of thesubject.
 14. Apparatus according to claim 1, wherein said fifthconnection means comprises: firstly, a shell constituted by first,second and third shell segments, of which the first shell segment coversthe thenar eminence of the hand of the subject, the second shell segmentcovers the second, third and fourth carpals and metacarpals of the handof the subject as far as the base of the fingers thereof, and the thirdshell segment covers the hypothenar eminence of the hand of the subject;and secondly, (a) a first peripheral strap disposed over said first andsecond shell segments and surrounding the hand of the subject with theexception of the thumb thereof at the level of the lower part of themetacarpal bones, and (b) a second peripheral strap surrounding thecarpus and passing over the first, second and third shell segments nearthe wrist of the hand of the subject, and further including a rubberband connecting the second peripheral strap to the fourth connectionmeans.
 15. Apparatus according to claim 14, including first and secondtensioners connecting the fifth connection means to the fourthconnection means, said first tensioner extending between the base of thethumb and the lower radial zone of the hand of the subject and thesecond tensioner extending between the lower cubital zone and thecentral palmar zone of the metacapus, said first and second tensionerspassing diagonally over the hand of the subject.
 16. Apparatus accordingto claim 14, wherein said second spring lever is disposed opposite thespace between the cubitus and the inner edge of the forearm of thesubject and it has its lower end fixed on said first shell segment ofthe hand somewhat ahead of the pisiform bone of the subject. 17.Apparatus according to claim 14, including a strap which surrounds thebase of the thumb of the hand of the subject said strap being carried bythe first shell segment of the fifth connection means.
 18. Apparatusaccording to claim 14, including, for each finger of the hand of thesubject a respective crossed elastic tensioner, a respective firstsupporting end fitting placed above the metacarpus of the subject and arespective second supporting end fitting placed above the second phalanxof the subject, wherein each said crossed elastic tensioner extendsbetween an associated said first supporting end fitting and anassociated said second supporting end fitting.
 19. Apparatus accordingto claim 18, wherein each said first supporting end fitting is carriedby the segment of the shell for the hand which corresponds to it, andeach said second supporting end fitting is carried by a finger stallwhich surrounds the end of the respective finger of the subject. 20.Apparatus according to claim 18, wherein each of said first and secondsupporting end fittings comprises a pin substantially perpendicular tothe bone of the hand which it surmounts, and a triangular adjustableorientation element capable of rotation around said pin.